Bilateral THR A thank-you and an introduction

[cr8tvt]

@Jp9294, @psychteach mentioned that you had anterior done at HSS and you were very happy. I just saw someone there yesterday who uses the mini-post approach (I need both done, probably bilateral). psychteach thought that you might be able to give me some advice as to why anterior vs. post and who you used and your overall experience.

You can see my other comments above re: my questions and decision-making. Starting above near top of page 3.
I pretty much hijacked @NewlyHip 's thread - but we're old friends now . . . (;-))

Thanks in advance -

 

[CodeGirl]

@cr8tvt There are situations where the anterior approach is not ideal: men with large muscle mass in the thighs, and people who have extra weight in the belly that might cause infection concerns with the incision. There may be others, the only way to know is to talk to an experienced Anterior surgeon. You have nothing to lose.

 

[frieds]

@cr8 I had minimally invasive posterior done in 5/28. My incision is 3.5" long on the rear side of thigh. My surgeon has perfected this technique and believes in it as there is generally less blood loss. Although there is some cut through muscle (unlike anterior) since it is such a small and precise incision, there is far less trauma than traditional posterior. I think my decision was based upon who I wanted as surgeon and what they knew was the best route with best possible outcome for me. I am happy - no bruising, no staples - just internal sutures and some glue

Tee


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[frieds]

@NewlyHip - congrats on the milestone today. Glad it's going well fellow hippie


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[cr8tvt]

@frieds - thanks - was this at HSS?

 

[frieds]

@cr8 -
No I am not local


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[psychteach]

@cr8tvt because @Jp9294 is doing so awesome, she is not on board much, I am in touch through pm's all the time as we are good buds. I believe her doctors name is Michael alexiandes ( or something like that) he is the anterior hip guy at HSS

Correct spelling :Michael M. Alexiades, MD






LTHR Direct Anterior May 19, 2014

 

[NewlyHip]

Met with my surgeon briefly yesterday and, without getting all the specifics on the installed prostheses, was informed that he installed a 44 mm metal femoral head on the right side and a 40 mm metal femoral head on the left side. He said these larger size heads are less prone to dislocate and offer a greater range of motion than smaller heads.

Because of my profession I have a tendency to research things to the nth degree and came across an article that folks still deciding how to proceed with this hip-surgery journey might find interesting — it discusses (in a hopefully not-too-esoteric manner) the advantages and disadvantages of these larger femoral heads:

https://www.researchgate.net/public...arger_femoral_heads_in_total_hip_arthroplasty

“The Pros and Cons of Using Larger Femoral Heads in Total Hip Arthroplasty”

"In conclusion, the biomechanical and clinical data support the finding of increased stability and increased ROM with use of larger diameter femoral heads—advantages that come at the cost of increased bearing surface wear, which may affect implant longevity. More clinical studies are needed to under- stand the clinical long-term effects of larger heads used with various bearing surfaces. Until these studies are completed, surgeons should use large femoral heads cautiously in young or active (high-demand) patients and in patients at low risk for instability. Large femoral heads provide an increased margin of error for stability in terms of component placement during surgery, but this advantage can be negated if the acetabular component is malpositioned."

 

[cr8tvt]

@NewlyHip, congratulations on your progress -
and thanks again for the info -

confusion abounds -
should i even ask about femoral head sizes? (btw, i'm not associated with a research institution, so i was unable to view the article - which may be a good thing, as i am obviously prone to (over)researching and (over)thinking things to a fault - )

- my guess is that the answer to this is no, it's the surgeon's choice not mine - (but i am curious)​

should i investigate alexiades if my first surgeon gave me such a good feeling? obviously, since alexiades only does anterior, that is his preferred approach, and mayman (the dr i saw) has his preferred approach for a variety of other good reasons . . .

- my guess is that the answer to this is no, since mini-posterior has good results as well and is preferred by some for a number of reasons, and i like mayman (but i'll probably like alexiades if i meet him) -​

at some point i just have to stop thinking about this, accept a decision and live with it - (but it's hard to know when that is . . . (;-))

(btw - mayman comes highly recommended, does all his own cutting and closing, and he said the ultimate result of bilateral vs. sequential is the same - the question is putting up with more initial "discomfort" vs prolonging the process - )

thanks for listening . . .

 

[allahere]

@cr8tvt - In my pre-op, being super nervous, i"ve seen 8 surgeons at Hss Maymen was giving a good impression, but when they started to send me pre -op paperwork, everything was messed up: a wrong name, even a wrong operation (a left knee instead of a right hip ) I didn't like it. I was asking every nurse I met, every assistant at Hss, my other doctors (not Hss) about who is great for hips. There several names who stood out several times: Westrich, Pellicci, Alexiades, Bostrom, and Su. They have subspecialties, a huge amount of surgeries every year, and of course different personalities. Not all of them take all insurances. The stuff and the office protocols are somewhat different. I went with Bostrom due to several personal circumstances. I"ll reserve my opinion about him til later, when I see the great results, hopefully: it's too early for me (17 days post op).The best part about Hss is low infection rates and nurses. I'm sure all these OS"s know what they do as much as it is possible in the field. But It's still a scary ordeal, I totally understand, and we patients try to calculate things into "a perfect picture". I give all this info b/c I think that patients deserve to know more about their doctors. Btw to be fair, my dental assistant"s father did thr with dr maymen and he is very happy with results - 5 yrs later he is skiing and totally forgot about his problems.

And as for the technicalities - no matter how many tech details you want to know (I wanted to know EVERYTHING !) - when you'll decide on your OS, you'll have to trust him re those choices. In my search for a doctor, I was learning from each, and asked more and more med. questions for each next one, and of course they all had answers, but I was only more confused b/c after each visit I only needed to learn and understand even more... Then I just gave up, somewhat, b/c I can't get a full medical education so quickly, even if for only one (very important to me) problem. And btw I do have a PhD and was praised many times for my research skills Although I DO understand that some amount of information is totally necessary for some patients, and this forum is filling the gap. People are certainly different: I have a dear friend who a week before my surgery did a much bigger surgery on his spine and he didn't want to know anything at all. When he saw the x-ray of what has been done on his neck and the spine a few days after his surgery, he fainted. He still prefers to know nothing...

Good luck with your decisions and the surgery!

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[beachgal]

I could make myself nuts quickly if I dissected to pieces every detail of how I think my surgery should go...and almost fell into that trap early on. Don't get me wrong, I believe in research and being as prepared with intelligent questions as I can be, but I'm not an OS by trade and I put myself in his shoes when my interrogation started. I had a full page of questions and quit about half way down. Dr. Mehrle does not perform anterior position surgeries. I have to trust that I've made the best choice in surgeons and also that he will use the method, the prosthesis, and whatever else I need that is the best for me. I actually spent more time sharing with him about our lifestyle, my activities, my hopes for life after a new hip, etc.

 

[allahere]

@NewlyHip - although we all answer more questions from @cr8 on YOUR threat here, I'm glad to hear that you're doing so well in post op. And btw I read all your articles, somehow I need to know... Thanks for the digging and sharing...

 

[cr8tvt]

@NewlyHip and fyi all -
the surgeon's office called and they have availability 7/3 -
so i'm gettin' it done -
thanks to ALL for your amazing concern, caring, advice, etc.
i'll let you know how it goes -
(it's nice to get the waiting over with quickly, but my body wants to hurl . . . (;-))

 

[beachgal]

@cr8tvt, I hope I get a phone call for an earlier surgery date. I'd go tomorrow....best of luck to you and I can't wait to read about your recovery "on the other side"...

 

[cr8tvt]

@beachgal - me too -

 

[psychteach]

@NewlyHip may I ask your profession? Researching and all. I have a graduates degree in library, research and information science and a graduates in psychology.. You are sounding like a librarian to me!!! Lol.. Great research skills you have .. A detective, a scientist??? Lol. The femoral head article is interesting. I was told by my OS that a large one is better but he also said , as your article mentions there are drawbacks .. He said he put in largest he could in me. Mine is a 36. But I am 5'2 and 105 pounds...




LTHR Direct Anterior May 19, 2014

 

[cr8tvt]

@psychteach - btw, i have a phd in edpsych but have worked most of my career doing business and marketing analytics and research -

i think that when any ortho sees a phd walk in, she should assume that this appointment is going WAY over schedule . . . (or perhaps run for the hills . . . )

 

[NewlyHip]

@NewlyHip may I ask your profession? He said he put in largest he could in me. Mine is a 36. But I am 5'2 and 105 pounds...

Attorney with a focus on business and real estate law and litigation. I’m one of the nice lawyers ;-)

I'm 6 foot 4 inches and 190 lbs. and my surgeon’s PA mentioned prior to surgery that, with my height, there was a good chance I would have the bone capacity required for these larger femoral heads.

 

[Jp9294]

@cr8tvt, hi! I did have the anterior approach at HSS and used Dr. Michael Alexiades. I did a lot of research and decided anterior was the way I wanted to go. I met dr. Alexiades and knew immediately he was the right doctor for me. I chose HSS because it had the one of the lowest infection rates in the country. My surgery was the first one in the morning and I was released the next day at 2:00 pm. I can't tell you which approach is better but I would make an appt with Dr Alexiades and get all your questions answered so you can make the right decision for you! Best of luck to you.

 

[NewlyHip]

I was curious to see what folks think about whether the pre-op-focused posts in my Recovery-Area thread might be better placed in a new thread in the Pre-Op Area. This way these posts might reach a larger audience of folks still awaiting surgery.